Automated surveillance of hospital-onset bacteremia and fungemia: feasibility and epidemiological results from a Dutch multicenter study

OBJECTIVE: Hospital-onset bacteremia and fungemia (HOB) has been suggested as a suitable and automatable surveillance target to include in surveillance programs, however differences in definitions across studies limit interpretation and large-scale implementation. We aimed to apply an automated surveillance system for HOB in multiple hospitals using a consensus definition, and describe HOB rates.

DESIGN AND SETTING: Retrospective cohort study in four Dutch hospitals: 1 tertiary hospital and 3 secondary hospitals.

PATIENTS: All patients admitted for at least one overnight stay between 2017 and 2021 were included, except patients in psychiatry wards.

METHODS: Data from the electronic health records and laboratory information system were used to identify HOBs based on the PRAISE consensus definition. HOB rates were calculated at ward and micro-organism-level.

RESULTS: Hospital-wide HOB rates varied from 1.0 to 1.9, and ICU rates varied from of 8.2 to 12.5 episodes per 1000 patient days. The median time between admission and HOB was 8-13 days. HOBs were predominantly caused by Enterobacterales, Enterococci, S. aureus and coagulase-negative staphylococci. Longitudinal HOB surveillance detected differences over time at ward and micro-organism level; for example increased HOB rates were observed during the COVID-19 pandemic. Sensitivity analyses demonstrated the impact of assumptions regarding the collection of confirmatory blood cultures for common commensals.

CONCLUSIONS: Applying a fully automated definition for HOB surveillance was feasible in multiple centers with different data infrastructures, and enabled detection of differences over time at ward and micro-organism-level. HOB surveillance may lead to prevention initiatives in the future.